Fort Walton Beach Council agenda — 09-04-12 regular — reading text

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Signature Date Print Name and Position Title DEP Agreement No. CM234, Attachment F, Page 1 of 3 s )100J8101 u01su94x3 ; uaua99a13y WISE) d3a3 : 6660 Sao o; Aink ivaweej e; ueffi qng :; uauayae:Rb INSTRUCTIONS FOR COMPLETING THE ATTACHMENT Grantee Fiscal Year Period: FROM: Month/ Year TO: Month/Year NOTE: THIS SHOULD BE THE GRANTEE' S FISCAL YEAR FROM ( MONTH /YEAR) TO MONTH/YEAR). Total State Financial Assistance Expended during Grantee' s most recently completed Fiscal Year: NOTE: THIS AMOUNT SHOULD BE THE TOTAL STATE FINANCIAL ASSISTANCE EXPENDED FROM ALL STATE AGENCIES, NOT JUST DEP. Total Federal Financial Assistance Expended during Grantee' s most recently completed Fiscal Year: NOTE: THIS AMOUNT SHOULD BE THE TOTAL FEDERAL FINANCIAL ASSISTANCE EXPENDED FROM ALL FEDERAL AGENCIES, NOT JUST THROUGH DEP. The Certification should be signed by your Chief Financial Officer. Please print the name and include the title and date of the signature. REMAINDER OF PAGE INTENTIONALLY LEFT BLANK DEP Agreement No. CM234, Attachment F, Page 2 of 3  sMooae ao1 uoisualx3 4u8ua88a6v 1uea0 d3a3 : 6 660 1o0 o; Ain luaweeiBe 1uei6 qng : luowLioelly f CERTIFICATION OF APPLICABILITY TO SINGLE AUDIT ACT REPORTING FREQUENTLY ASKED QUESTIONS 1. Question: Can I fax the form to you? Answer: Yes, you can fax the Certification form, the fax number is 850/ 245 -2411. 2. Question: How can I submit the form if our audit is not completed by the due date of this letter? Answer: You should be able to complete the form from the information in your accounting system. This is just to let our Office of the Inspector General know which entities they should be getting an audit from. If you are under the threshold you do not have to submit a copy of your audit, only the Certification form. 3. Question: Do you only want what we received from DEP? Answer: No, the Single Audit is the TOTAL AMOUNT of funds that you expended towards all state or federal grants that you receive. You should list those that are specific to DEP on the form. 4. Question: Do I have to submit the completed form and a copy of my audit? Answer: No, you do not have to submit your audit unless you are over the threshold of 500, 000. If you would prefer to submit your audit ( CAFR) instead of the form, that is fine. 5. Question: Our CAFR will not be ready before your due date and we don' t have the information necessary to complete the certification. Can we get an extension? Answer: Yes, just send us an Email letting us know when you will have your CAFR completed and we will place the Email with your letter in our file so that you don' t get a 2 °a notice. 6. Question: Can I submit my Certification Form or CAFR electronically? Answer: Yes, you can submit them by Email to Debbie.ske1ton(2dep.state.fl.us REMAINDER OF PAGE INTENTIONALLY LEFT BLANK DEP Agreement No. CM234, Attachment F, Page 3 of 3  s )Iooaa aoI uoisua }x3 luawaaaBV luea0 d3f3d : 6460 3oO o; Alnp; uaweejBe Iuea6 qng :; uauayoe; }d r Attachment J Photographer Release Form Florida Department of Environmental Protection Photographer: Please Print Name) Address: City: State: Zip Code: Phone Number: area code + number) Email: License and Indemnification I certify that I am the photographer and owner of the photograph(s) being submitted and am 18 years of age or older. I hereby grant the Florida Department ofEnvironmental Protection the royalty -free and non -exclusive right to distribute, publish and use the photograph( s) submitted herewith ( "the Work ") to promote the Florida Department of Environmental Protection. Uses may include, but are not limited to promotion of the Florida Department of Environmental Protection, its publications, employees, volunteers, and properties in any way, including on the Internet, in print publications, as distributed to the media, and in commercial products. The Florida Department of Environmental Protection reserves the right to use /not use any Work as deemed appropriate by the Florida Department of Environmental Protection. No Work will be returned once submitted. I hereby acknowledge that the Florida Department of Environmental Protection shall bear no responsibility whatsoever for protecting the Work against third party infringement of my copyright interest or other intellectual property rights or other rights I may hold in such Work, and in no way shall be responsible for any losses I may suffer as a result of any such infringement; and I hereby represent and warrant that the Work does not infringe the rights of any other individual or entity. I hereby unconditionally release, hold harmless and indemnify Florida Department of Environmental Protection, its employees, volunteers, and representatives of and from all claims, liabilities and losses arising out of or in connection with the Florida Department of Environmental Protection' s use of the Work. This release and indemnification shall be binding upon me, and my heirs, executors, administrators and assigns. I have read and understand the terms of this release. Photographer Signature: Date: Photo Filename( s): _ Location of photo shoot: Name of Person Accepting Photographs: DEP Agreement No. CM234, Attachment J, Page 1 of 2  s )iooa8 col uoisuaax3 luawBGABV lue.i0 d3a=1 : 6660 loo o; Ajnp luawaaa6e luej6 qnS : luawyoe:RV Model Release Form: Photo/ Video /Audio This photo release form will be used for all State of Florida—Department of Environmental Protection brochures, websites, displays, articles, magazines, programs, advertisements or events. Photo Release for Adults I, being 18 years or older, hereby consent that the videotapes, photographs and/ or motion picture film in which I appear, and/ or audio recordings made of my voice may be used by the Florida Department of Environmental Protection, its assigns or successors, in whatever way they desire, including television without compensation. Furthermore, I hereby consent that such photographs, films, negatives and recordings, and the plates and/ or tapes from which they are made shall be their property, and they shall have the right to sell, duplicate, reproduce, and make other lawful uses of such photographs, films, recordings, places and tapes as they may desire, free and clear of any claim whatever on my part in perpetuity. IN WITNESS WHEREOF I have hereunto set my hand, in the State of Florida, this day of , 2 Location: Signature_ Name ( Print) Address City State Zip Photo Release for Minors I being Parent/Guardian of , hereby consent that the videotapes, photographs and/ or motion picture film for which he/she posed, and/ or audio recordings made of his/her voice may be used by the Florida Department of Environmental Protection, its assigns or successors, in whatever way they desire,